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Management of Alcohol Withdrawal in the Emergency Department: Current Perspectives

Authors Wolf C, Curry A, Nacht J, Simpson SA

Received 19 October 2019

Accepted for publication 18 February 2020

Published 19 March 2020 Volume 2020:12 Pages 53—65


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Dr Hans-Christoph Pape

Chelsea Wolf,1,2 Ashley Curry,1,2 Jacob Nacht,1,3 Scott A Simpson1,2

1Denver Health Medical Center, Denver, CO, USA; 2Department of Psychiatry, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; 3Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

Correspondence: Chelsea Wolf
Department of Psychiatry, 777 Bannock Street MC 0490, Denver, CO 80204, USA
Tel +1 303 602 6890
Fax +1 303 602 6930

Abstract: Alcohol withdrawal syndrome (AWS) is a common, heterogenous, and life-threatening complication of alcohol use disorder (AUD). AUD is a leading cause of worldwide mortality, and many patients with AUD will develop AWS during their ED course. This review summarizes the epidemiology, pathology, and management of AWS and AUD in the emergency setting. The time course of AWS and its impact on ED treatment is emphasized. Once AWS is diagnosed, symptom-triggered benzodiazepine administration remains the most commonly provided treatment but may not be appropriate for patients with significant medical or psychiatric comorbidity or pending discharge. In these cases, ED clinicians may consider short courses of barbiturates or alternative regimens based on novel anticonvulsants. Specific treatment protocols are enumerated for clinical practice. Finally, emergency providers must not only manage acute patients’ AWS but also lay the foundation for successful treatment of AUD. An approach to the disposition of the patient with AUD is presented. The authors examine shortcomings in the extant literature and suggest opportunities for further study.

Keywords: alcohol withdrawal syndrome, benzodiazepine, phenobarbital, delirium tremens, gabapentin, alcohol use disorder

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